1/45. Postparotidectomy fistula: a different treatment for an old problem.

There is little consensus on the optimal management of postparotidectomy salivary fistulas. Timely treatment is important since fistulas may result in wound dehiscence and infection. Management options include pressure dressings, total parotidectomy, tympanic neurectomy, graft interpositioning, surgical closure of the tract, radiation therapy, and pharmacotherapy. Unfortunately, many therapies require weeks to months for resolution and possess additional risks. The affected patient often suffers social embarrassment from the drainage. Through our work with neurologically impaired children with sialorrhea, we have had success with using glycopyrrolate, an anticholinergic frequently used to decrease salivary secretions. We present a case of a patient with a postparotidectomy fistula which was successfully treated with glycopyrrolate and pressure dressings. The rationale and potential use of glycopyrrolate for the treatment of a salivary fistula are the focus of this presentation. ( info)

A 30-year-old woman developed a fistula of the Wharton's duct following excision of the submandibular gland. The contribution of conventional fistulography, MRI and MRI fistulography in detecting the exact extent of the fistula is discussed. ( info)

3/45. Salivary fistulae.

Three cases of unusual cervical fistulae are presented with a review of the literature to caution against labelling all lateral cervical fistulae as simple branchial fistulae or midline ones as dermoid cysts. ( info)

4/45. Cervical tumor by ectopic salivary gland.

Heterotopic salivary tissue is a rare lesion, although most authors agree that anomalous embryologic development of salivary tissue is the main cause. One case of cervical tumor by ectopic salivary gland is reported, and existent literature is reviewed. A 26-year-old woman was operated on for a cystic tumor in the midline of the neck diagnosed as thyroglossal cyst in the hyoid region. After Sistrunk operation, the recurrence was immediate. A second operation was performed, and a solid tumor located between muscles of the tongue was resected. A long tract opening in recurrent cervical cystic tumor was also removed. No recurrence was evident at 1 year after surgery. Pathological examination of the excised mass revealed an ectopic salivary gland with serous and mucinous acini located between muscles of the tongue. This is a rare case report of a cervical fistula by ectopic salivary gland surrounded by muscles of the tongue draining into a cystic tumor in the hyoid midline lesion. recurrence of thyroglossal cyst after a correct surgical resection must be suspected as an ectopic salivary tissue. Also when a cystic neck tumor is present, an ectopic salivary gland must be suspected. ( info)

A patient had a delayed complication of parotid trauma, namely a sialocele. He was successfully treated by repeated needle aspiration of the fluid. An experiment using 30 dogs was then done. On each dog, one parotid gland was used as a control, the other parotid was treated by one of three methods that the author felt would be most satisfactory. Needle aspiration was found to be the simplest and the most effective manner of treatment, because the proximal duct quickly becomes obstructed with the cessation of salivary flow, disappearance of the sialocele, and later parotid atrophy. One patient and 30 dogs are surely not conclusive proof of what would be proper treatment, but the author hopes that this paper will stimulate otolaryngologists to try this method if confronted with a similar problem. ( info)

We report on the successful treatment with botulinum toxin type A local injections of a salivary fistula that occurred after superficial parotidectomy. In a 58-year-old woman, transcutaneous discharge of saliva in the preauricular region had persisted in spite of 2 surgical revisions. Moreover, facial weakness and synkinesis had developed as a result of an iatrogenic lesion that had occurred at the time of primary surgery and required immediate reanastomosis of the main nerve trunk. Botulinum toxin A was injected into the deep lobe of the remaining parotid gland under ultrasonographic guidance. Additionally, botulinum toxin A was injected into the left orbicularis oculi muscle in order to improve the synkinesis. No adverse effects were observed. The sialorrhea was stopped for 11 months, and the synkinesis of the facial muscles was reduced significantly for 4 months. We conclude that botulinum toxin A injection is a successful alternative for the treatment of chronic salivary fistula. ( info)

Although the use of rigid fixation techniques has become widespread for the treatment of mandible fractures, indications still remain for the utilization of biphasic external pin fixation in patients who suffer cranio-maxillofacial trauma. The treatment of continuity defects of the mandible secondary to avulsive injuries or ablative surgery is a primary indication for the utilization of biphasic external pin fixation. The placement of biphasic external pins requires an understanding of the surgical anatomy surrounding the mandible. In this article, the authors discuss the indications for, contraindications for, and complications associated with the use of biphasic external pin fixation, describe the procedure, and present a case report of a patient with parotid salivary fistula secondary to the placement of external pin fixation. ( info)

Two patients, one with a persistent salivary fistula after surgery for a skin tumor overlying the parotid region, and the other with a ranula recurrent after surgery, were treated with low-dose irradiation. Both problems resolved after a total dose of less than 30 Gy, and neither patient experienced xerostomia. In selected patients, low-dose radiation therapy offers a solution to persistent salivary flow refractory to surgical management. ( info)

10/45. Reconstruction of a circular defect of the hypopharynx and cervical part of esophagus by a free jejunal flap (case report).

patients with impaired continuity of the upper gastrointestinal tract are dependent on gastrostomy or jejunostomy tube feeds, which significantly reduce their quality of life. Reconstruction of the hypopharynx and esophagus is desirable in cases of congenital deformities, corrosive injuries, or defects after tumor resections. Free flap allows for easier reconstruction of head and neck defects. In this article, the authors present a case of complete hypopharynx closure in an oncology patient with a larynxcarcinoma. The patient is a 60-year-old male diagnosed in 2002 with epidermoid carcinoma of larynx. The patient underwent laser resection of the tumor followed by radiotherapy and chemotherapy. In 2003 the patient underwent pharyngo - laryngectomy for relapse of the larynxcarcinoma. Postoperatively the patient developed pharyngo - cutaneous fistula, which was reconstructed at the otorhinolaryngology department by a muscle - cutaneous flap from the pectoralis major muscle. During the course of healing the patient developed complete hypopharynx and cervical esophagus closure. Free flap of jejunum was recommended. The surgery team used a 10 cm long section of jejunum; the recipient blood vessels were arteria transversa colli and internal jugular vein. On the second day after the surgery patient developed salivary fistula in the wound. The fistula healed spontaneously in five weeks. Pharyngoscopy revealed that the transplanted jejunum was fully vital. Free flap of the jejunum allowed for upper gastrointestinal tract reconstruction and allowed the patient to restart peroral intake. ( info)